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Monday, January 6, 2014

Guest post: The two kinds of mothers in medicine

It seems to me, in reading these posts, that mothers in medicine seem to fall into two main groups. First, those that are fully committed to their work, feel no regret about choosing medicine as a career, see working as a positive thing in their lives, and suffer no, or very little, mother guilt. The second group suffer frequently, if not perpetually, from cognitive dissonance between medicine and family. This group is no less committed as doctors or as mothers, but struggle to marry the two without great dollops of mother guilt. I am in the second group and find myself wondering, as I ride another wave of dissonance, how do I get into the first group? Clearly there are factors at play which make the elusive balance harder, but even if you allow for those, is there something inherent in my nature, beliefs or values that means I will always have these ups and downs? What do I have to develop/cultivate/realize to overcome my dissonance and mother guilt to join the ranks of the first group, to which I ache to join? In theory, I believe that working mothers are a good role model for children, that fathers step into the home more when a woman works which adds more for the children, that mothers make excellent workers and doctors, that workplaces need to support working parents and indeed workers without children to achieve a happy balance but why can't I shake these feelings of conflict? Why can I think my way to balance but can't feel my way? I had a very inadequate home as a child, parenting that raised the interest of child protection agencies. Is this why? Which bits are me and which are over protective parenting making sure my children don't have the pain and loss that I suffered? Would I feel this way no matter what job I did? I think not, because I read so much indecision, conflict and even anguish in the posts on mothersinmedicine. I also read the comments to those posts from mothers in the first group, and I press my nose up to the glass of that group, and yearn to open the door and walk inside. So how do I join you, centered un-conflicted mothers in medicine? Or is that an unattainable dream for me?

18 comments:

I don't think it's about changing who you are or even changing your perspective. I think every mother has to find the combination of work/home that works best for her and her family. That combination can and should look different for different people! Also, we all go through periods of time when we are more or less happy with how we are balancing things.

And don't delude yourself -- even the "committed to work" mothers who love what they do and aren't working 80 hours per week anymore feel a yearning to be with their kids when they are at work and a sense of guilt for missing things from time to time. I think that's just human nature. And, of course, if you're a resident working 80 hours per week, or you're unhappy at your job, these feelings are likely to be amplified.

For me, the way I feel better about my choices is in acknowledging that is what they are: choices. And that I am lucky to have them. And then in permitting myself to feel happy when I am not with my daughter. Some days it is easier to do this than others. I also remind myself that the family where one parent works full time and the other stays at home is a recipe for disaster if something should happen to (especially) the working parent, since re-entry into the workforce can be really difficult after a hiatus. Having both of us work, in our family, is an insurance policy that is not really optional since we have no family help.

Fight the patriarchy. You can do it! You can feel at ease with your choices.

I would recommend a technique called cognitive restructuring, which is just what you're doing when you think the truth after having a guilty thought, except you write it down. So you fold a piece of paper in half lengthwise. On the left you write the repeating negative thought. Then next toto it on they gritting that, write the truth. It is a very powerful technique fromCBT.

"toto it on they gritting that" @#$#ing auto correct. #$@#%ing ipad."to it on the other half"

Also, I would dissent with the idea that all moms feel guilty about parenting/work choices. I have never felt guilty about my parenting. My kids are turning out amazing, so I don't think there's anything I could do that would be better. If I'm not there for something, they're learning independence and to value things for their own merits rather than my approval. If I'm there for something, then I'm there.

My mom also worked full-time and I never felt like she was doing a bad job. She taught me that her life and her work are important, meaning that when I grew up, my life and my work are important too. I'm not trapped by the belief that I have to be at every soccer game or that there even have to be soccer games. (Also not trapped by the belief my house has to be clean.)

Your story does sound a bit like Dr. Isis (at isisthescientist.com). Many ages ago she was talking about feeling guilty for not being a perfect homemaker on top of an R1 professor. More recently she's opened up about her childhood abuse and neglect-- her mom was definitely not a perfect homemaker. So I wouldn't discount your childhood experiences influencing your views. But it's society that's selling the June Cleaver model as ideal mother. That's limited. Great mothers come in many more varieties, most definitely including working moms. You know that intellectually, but maybe haven't internalized it yet.

I agree with OMDG, I think everyone has some degree of internal conflict---whether they are vocal about it or not. I also don't think you're going to 100% be happy to be working every minute you're at work, whether you have kids or not. There were many many times during my training, for example, where I felt terrible for missing important events in the lives of my close friends and family (weddings, birthdays, surgeries). Life is about making choices, and if you are comfortable with those choices the majority of the time (and its seems you are?) then thats the best you can get. I am unapologetically happy to work full-time and have my kids in daycare...but yesterday my 4-year old was crying that he didn't want to go to school and wanted to hang out with me, and this morning has been rough. But I'm sure tomorrow he'll be fine, and I'll be fine again. I also don't like missing every single school field trip----but they are scheduled on the one day I HAVE to be in clinic...

I've been out of residency for 9 years, full time family practice, two daughters 12 and 6. I can't say my life is "balanced," but I do feel at "peace" with my life.

Speaking for what has worked for me:

-Refuse to feel guilty for not being perfect (at home or at work). -Take every vacation day that is due.-Don't buy into the competition over homemade cupcakes (gluten, egg and dairy free). A bag of grapes works well.-Don't allow reception to double or triple book your schedule when you just can't work that way. I'm on production, and I work as hard as I need to for my personal goals, no harder. -Schedule tasks like hair cuts into your routine. Leaving at 3 p.m. one day every 6 weeks is not going to hurt anyone.-Set a bedtime for your kids and maintain it, for the sanity of everyone. After 8:30 p.m, it is personal time for my husband and me.-Say no to committees that you just don't care about, and avoid meetings that serve no purpose besides "face time."-Refuse to feel personally responsible for the lousy decisions your patients make. It is their life, let them live it. Let them own the consequences.-It's going to be hard, but let your children own their lives and decisions too. Refuse to take it as personal attack when your daughter or son wants to do it their way. You are planting and cultivating individuals, not clones. I see so many friends personally mourning when their child wants to give up soccer or stop playing an instrument.

In terms of resources, I recommend Debora Spar's book "Wonder Women: Sex, Power and the Quest for Perfection." Her message it to be "good enough."

I'm decidedly in the second group, not the first, and I actually don't feel conflicted at all about being less invested in medicine than I am in my family. For me, a real moment of clarity when I was early in the working mother years and still working full-time was when one of my mentors gave me her tip - she left by 5pm on Fridays to make sure she could make and eat dinner with her kids that night. Considering that I had been running out the door at 4:15 every single day of the week since my first day back from maternity leave (nursing baby got hungry), and still felt work was taking too much from my family life, her tip showed me how career invested I didn't want to be. (And, for the record, I respect this woman very much as a physician, professional, and mother; I just want to make different choices for myself and my family.) Unless the patient is actually coding in front of me, there is no patient or patient problem I care about more than getting home for dinner with my kids, and that is my attitude all day in clinic, which keeps me on track, schedule-wise, to be done in time to make that happen.

i love the tips from other moms above - including the practical ones! i can honestly say that am happy with my balance of full time (though decent hours!') medicine. but sometimes when i feel guilt ABOUT liking my current balance, i think about how proud i would be of my daughter (currently not even 2 yet) if she had a full career that she loved. i am setting a good example for her. plus, i do enjoy my work AND the financial benefits it brings (including taking some of the stay-at-home parent chores OFF of the table for me so that the time i am home can be more of a pure parenting role).

I am not yet a mom but am the child of a mother who was very busy, and although she was not a physician, her job as a researcher would require her to travel internationally for six weeks at a time, and she probably worked in the 60+ hours per week range (and still does). We would often need to "reschedule" birthdays because she was out of town, she certainly didn't make it to every sporting event or dance recital, and even today, she told me she wouldn't be able to make it to my first wedding dress fitting because of work. For me, it really wasn't a big deal. It was always evident that she loved both her job and her family. Even though I now know she felt guilty being away, this was never apparent from my perspective as a child which was totally fine. All three of us turned out well and have great relationships with our parents.

I have never wished that my mom had stayed at home or was less busy. She was an amazing role model, and I don't think I would have had the resilience I have had it not been for her example. Growing up, she made a big effort to take us to the office/lab occasionally (usually for lunch) so that we would have some kind of understanding of what she was doing while she was away (I think this was really helpful). She always brought me to take your daughter to work day (she was the only female researcher/faculty member in her department), and would often include the whole family in her work travels (most of my vacations growing up coincided with some kind of research conference). I did miss her at times, and was sad that she was gone, but what I remember most was how special she made the time we did spend together. When she was spending time with us, she was fully invested. She never once made cupcakes for a bake sale, but she did show me how to bake and decorate my own (with some supervision, of course) if they were needed for school, which did way more for me than having perfect Cake Boss worthy mini-pieces of art. My dad did stay home with us for a couple years while he was working on our masters degree when we were infant, 3 and 5, but to be honest, I don't really remember it. I think it was probably easier on my parents that it was necessary for us. We had several wonderful nannies, who we developed wonderful relationships with. I think these people enhanced our family life and it's amazing to still be in touch with them now more than twenty years later (one of them is attending my wedding this summer).

Long story short, after being the child of a busy working mom, I can't imagine myself doing anything different as I'm now contemplating motherhood. Nothing was perfect, our house was never Martha Stewart ready, we'd have an occasional miscommunication about pick-ups from activities (which resulted in the purchase of my first cell phone), and my mom took a fair amount of judgement from the PTA (which is probably why I have a weird unreasonable resentment toward SAHMs). However, I grew up with an amazing strong woman as my role model, my parents modeled a relationship where both partners contributed to the bank account and the chores (which has laid the groundwork for me to have what I think is a healthy, equal partner relationship), my brother sister and I are very independent people who were not in shock the first time we were away from home and had to care for ourselves, and my younger brother has a huge respect for women. I wouldn't ask her to change a thing about her choices.

**A side note, when my mom was gone, she would always leave (what I can only assume was) a stack of hand written notes and occasionally little trinkets for my dad to leave under our pillows each night. I still have some of them. They were mostly 1-2 sentences, but they helped me know my mom was thinking about me even if she wasn't physically present. I still tear up a little when I think about it and how much it showed she cared. Little things like that make such a huge impact.

Great post & great comment thread.I am a new mom of a 7 month old boy & a family doctor in a small city in Canada. I do family practice office, low-risk obstetrics and ER. I am just learning how to balance my day, but even before my son was born, I would say I fall into the 2nd category. When I started my practice I was so idealistic, and thought I could meet everyone's needs, but it didn't take long to see that I could not. No matter how much I tried to tweak my schedule to offer more appointments for patients, it seemed I could never satisfy everyone. I am starting to realize that I can't make everyone happy, but I can make myself and my family happy by putting our needs first and knowing when to say "No" and when it's time to go home. My schedule is not perfect by any stretch, and it's a struggle to stay on time so I can get home for dinner, but I am working on it. I love some of the ideas & suggestions above. And I love this website! Thanks!

Trying to figure out which group I think I am in versus which group readers think I may be in. I'm in residency working the 80 hour plus work weeks that OMDG referenced. I think I fluctuate back and forth. Docmom's points are ones that I live by every single day. She is spot on!

I often tell myself that even if I were, for example, someone working 2-3 hourly jobs to make ends' meet, I would likely feel the same guilt about not spending time with my husband and son. I think of my ancestors who worked long and hard so that I could follow my dreams; they worked long hours, they fought against discrimination that I can never imagine. They may have spent even less time with their families.

I'm a doctor because it's my life's goal. I know many people who work long hours (though not as many as mine) in mundane jobs who also feel guilty about not being home enough and it's not their passion and they are not living their dream. I'll take the working long and hard and following my dream route. And I look forward to the day when I'm an Attending with a much better schedule than an Attending.

Oh and commit yourself daily to being the very best parent that you can be. Doesn't have to fit anyone else's mold. Doesn't have to be better than anyone, just needs to be your best and keep your kids healthy and alive!

I'm definitely in the second group. I've struggled with my guilt of being away from home and my guilt of not having "professional ambition." I made the difficult decision to not persue a fellowship this last year. At some point, what I'm doing and what I've already accomplished has just got to be good enough.

Im also in the second group, but for me it has gotten easier once I came to peace with my own upbringing, my childhood and my mother. I started this wanting to be a perfect mother according to my own standards, and on the way Ive found out that I have to be less hard on myself... after all, the best mothers are most often not the perfect ones.

I got to this post through the roundup of most viewed posts, and it really resonated. I think most working Moms are in the second group, and the guilt never goes away. It's hardest for me when my kids are sick and I'm not the one wiping their noses and taking care of them. We actually wrote a blog post on the topic in honor of Mother's Day, and it just went up today: http://blog.medicalscrubscollection.com/the-working-mothers-guilt/

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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